[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Central nervous system](https://durgical.com/en/general-pathology/areas/cns/) › Perinatal brain injury

# Perinatal brain injury

- Lesion

Babies born early or deprived of oxygen around birth can bleed into fragile brain tissue or lose white matter, leading to cerebral palsy.

Updated Nov 12, 2026

## Key points

- Germinal matrix hemorrhage: in preterm infants, at the junction of the thalamus and caudate; it can rupture into the ventricles and cause hydrocephalus.
- Periventricular leukomalacia: chalky yellow infarcts in the white matter next to the lateral ventricles, typical of prematurity; gives spastic diplegia.
- Multicystic encephalopathy: extensive cystic destruction of white and grey matter after severe injury.
- Ulegyria: thin, scarred, mushroom-shaped gyri from term hypoxic injury in the depths of sulci.
- Status marmoratus: marbled basal ganglia and thalamus from neuron loss and aberrant myelination.
- Kernicterus: bilirubin staining of basal ganglia and hippocampus in severe neonatal jaundice.

## What it is

The brain of the preterm infant has a fragile, highly vascular germinal matrix near the ventricles and white matter that is very sensitive to ischemia and inflammation. Bleeding from the germinal matrix and periventricular infarcts are typical of prematurity. In term infants, hypoxia-ischemia around birth damages cortex and deep grey matter. These injuries are major causes of cerebral palsy, a non-progressive disorder of movement and posture.

## Step by step

- The preterm brain has fragile germinal matrix vessels and immature autoregulation of blood flow.
- Swings in blood pressure or oxygen rupture these vessels or leave white matter ischemic.
- Infection and inflammation in pregnancy add cytokine injury to oligodendrocyte precursors.
- White matter dies and calcifies; bleeding blocks CSF pathways.
- Motor tracts near the ventricles are lost, giving a non-progressive motor disability.

## Perinatal brain lesions by maturity

| Lesion | Mostly in | Where | Late result |
| --- | --- | --- | --- |
| Germinal matrix hemorrhage | Preterm | Subependymal, caudate-thalamic groove; can enter ventricles | Hydrocephalus, cerebral palsy |
| [Periventricular leukomalacia](https://durgical.com/en/conditions/cerebral-palsy/) | Preterm | Deep white matter next to the ventricles | Spastic diplegia |
| Multicystic encephalopathy | Preterm or term, severe injury | Widespread white and grey matter | Severe disability |
| Ulegyria | Term | Cortex at the depths of sulci | Epilepsy, cortical deficits |
| Status marmoratus | Term | Basal ganglia and thalamus | Movement disorders (dyskinetic palsy) |
| [Kernicterus](https://durgical.com/en/conditions/neonatal-jaundice/) | Term or preterm with very high bilirubin | Basal ganglia, hippocampus, brainstem nuclei | Athetosis, hearing loss |

## Clinical notes

- Cranial ultrasound in preterm infants screens for germinal matrix hemorrhage and leukomalacia.
- Cerebral palsy is non-progressive, but its features change as the child grows.

## Memory aid

Preterm brains bleed in the matrix and starve in the white matter; term brains scar in the cortex and marble in the basal ganglia.

## Test yourself

Think of the answer, then tap the question to see it.

## Where does germinal matrix hemorrhage arise?

In the subependymal germinal matrix near the caudate-thalamic junction of preterm infants; it can extend into the ventricles.

## Which motor pattern follows periventricular leukomalacia?

Spastic diplegia, because leg fibres of the corticospinal tract run closest to the ventricles.

## What is kernicterus?

Yellow bilirubin staining and injury of the basal ganglia, hippocampus and brainstem nuclei in severe neonatal hyperbilirubinemia.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/perinatal-brain-injury/)

[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Elsewhere in DurgiPedia

- [Fetal lung, kidney and brain maturation: what preterm birth interrupts](https://durgical.com/en/embryology/fetal-lung-kidney-and-brain-maturation-what-preterm-birth-interrupts/)

## Connections

## Related 4

- [Global hypoxic-ischemic brain injury](https://durgical.com/en/general-pathology/global-hypoxic-ischemic-brain-injury/)
- [Brain malformations: forebrain and posterior fossa](https://durgical.com/en/general-pathology/brain-malformations-forebrain-and-posterior-fossa/)
- [Prematurity and fetal growth restriction](https://durgical.com/en/general-pathology/prematurity-and-fetal-growth-restriction/)
- [Neonatal respiratory distress syndrome: surfactant and hyaline membranes](https://durgical.com/en/general-pathology/neonatal-respiratory-distress-syndrome-surfactant-and-hyaline-membranes/)

## Related conditions 5

- [Cerebral palsy](https://durgical.com/en/conditions/cerebral-palsy/)
- [Perinatal asphyxia and hypoxic-ischaemic encephalopathy](https://durgical.com/en/conditions/perinatal-asphyxia-and-hypoxic-ischaemic-encephalopathy/)
- [Prematurity and its complications](https://durgical.com/en/conditions/prematurity-and-its-complications/)
- [Neonatal jaundice](https://durgical.com/en/conditions/neonatal-jaundice/)
- [Hydrocephalus](https://durgical.com/en/conditions/hydrocephalus/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Cerebral Palsy | CP | MedlinePlus](https://medlineplus.gov/cerebralpalsy.html) (MedlinePlus, US National Library of Medicine, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/general-pathology/perinatal-brain-injury/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/perinatal-brain-injury/